Levels, trends, and determinants of female covert use of contraception in Sub-Saharan Africa

Author:

Natalie Gasca

Mentor:

Stan Becker, Professor of Population, Family and Reproductive Health, Johns Hopkins University

In Sub-Saharan African (SSA) countries, substantial numbers of monogamously married and in-union women use contraceptives without their partner’s knowledge. Covert use is not ideal but is employed due to threats of violence, societal repercussions, and partner tension. Four hypotheses are explored here: (1) Covert use declines as contraceptive prevalence increases; (2) Covert use is more prevalent among women who are older, less educated, in rural areas, and in relationships with substantial differences between partner ages or schooling; and (3) Injectable contraception, where available, is more prevalent among covert users than open users. We utilized DHS couple reports from 9 SSA countries that had experienced a 10% increase in modern contraceptive use throughout 5 years or more, as reported by married women. All surveys were required to include partners’ responses regarding current family planning and were compared to measure covert use. Using husband’s weights and z-tests for all hypotheses, covert use significantly increased over time. The following predominant trends were noted: women with less schooling were more frequently covert users, and injectables were more commonly used by covert than open users. These public health findings can aid family planning programs in assessing covert use, understanding the demand for certain methods, and preserving women’s privacy when necessary in SSA countries.